Salamanders Young Burn Survivors > Facts and Figures > Burns and The Body

Almost every system in the body may be affected by a burn.

When a burn occurs, fluid leaks out of the cells and blood vessels, and this causes swelling. The swelling can be local (around the burned area) or systemic (throughout the body). The larger the burn, the more swelling usually occurs. If a patient has face burns, the eyes may swell shut, making it impossible to open them. The swelling will start to go down in two to three days.

Normal skin is a waterproof covering for the body. When it is damaged, body fluids (liquids) leak out. Burn patients suffer huge losses of fluid, which must be replaced at once and continuously to keep the kidneys working.

Without the skin's protective layer, it is very easy for burn patients to get an infection (to catch germs), which their burn-damaged immune system cannot fight properly.

If burns are on the face or neck, or the patient has an inhalation injury (damage to the lungs), breathing may be a problem.

Burn patients need to eat more than usual to help their wounds heal, often for weeks or months after the injury.

If a burn damages the nerve endings in the skin, the nerves will have to re-grow. Nerve re-growth is often slow and skin sensations may be permanently changed. (Hot, cold, wet, dry, sharp, dull, smooth, rough, soft, hard and pain are all sensations a person feels from the skin.)

When it is hot, the body must cool itself or it will overheat. To do this, the blood vessels at the skin surface dilate (enlarge), and we sweat or perspire. In skin that has healed after a burn, both the sweat glands and the surface blood vessels have been damaged, so it is harder for the body to cool itself. Because of the changes in sweat glands, itching and abnormal sweating are often a problem.

There is a period of time after a burn when a variety of emotions is normal. This roller coaster of feelings doesn't last forever. Most patients report that emotions start calming again in one to three months.

Nearly every burn patient has trouble sleeping. Itching, temperature regulation problems (you're too hot or too cold), anxiety (worry), and pain can all cause restless sleep.

Skin Healing

The body has two main ways of healing a skin wound.
When the wound is superficial (shallow), healthy skin cells multiply and move across the open wound to cover it. This process is called epithelialisation.
When the wound is deeper, and there are no healthy skin cells left, the body closes the wound by pulling the skin around the edges in toward the centre. This is called contraction. Contraction can pull surrounding healthy tissue out of shape. It can also form tight scar bands across joints, which cause loss of normal movement. (These bands of scar tissue are called "contractures".)

When a wound is too large or deep for the body to heal itself, a skin graft is needed.
In skin graft surgery, the first step is to cut away the dead burned skin. This is called excision. The second step is to cover the area with donor skin, which is a patch of healthy skin that is transplanted (moved) from another area of the body. A graft is said to "take" when new blood vessels and scar tissue form in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Split-thickness skin grafts (STSG) are grafts that include all the outside layer of skin (the epidermis) and part of the layer underneath (the dermis). If there is too little donor skin available, the graft is meshed (which means cutting tiny holes in the donor skin) so it can be stretched to cover a bigger area. The advantage of STSG is that it uses less skin, which damages the donor site less, and it is more likely that the graft will survive. The disadvantage of STSG is that it tends to contract more than full-thickness skin grafts.
Full-thickness skin grafts (FTSG) include both the epidermis and all of the dermis. The advantages of this type of graft are that it is less likely to contract, it looks more normal, and it is more resistant to injury.
Cultured skin can sometimes be used if a badly-burned person doesn't have enough healthy donor skin left. Doctors take a very small piece of healthy skin from the burned person and culture (grow) it in a laboratory. In two or three weeks this can make enough "cultured skin" to cover the burned areas.

The healing of any large wound will leave a scar.
If a person has a skin graft, scar tissue will form. The place the donor skin came from can also scar.
Scar tissue is made of collagen (a tough, fibrous protein made by cells called fibroblasts, which rebuild all injuries). In a large wound, so much fibre is needed that it is visible, and we call it a scar. Because scar tissue is made of fibres, not skin cells, it is stronger than ordinary skin. Unlike skin, it does not have hairs, sweat glands or blood vessels. It may look shiny and is often a different colour from the skin around it.
The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon's skills. Many things can affect how bad a scar is, including the size and depth of the wound, the blood supply to the area, the thickness and colour of your skin, and the position of the scar.
After the wound has healed, a scar continues to change as new collagen and blood are produced. Scars usually look worse before they look better. With time, scars soften and look more normal, but burn scars never disappear completely.

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